Date of Application *

Pet Name: *

General Information

First Name: *

Middle Name: *

Last Name *

Telephone Number: *

Cell Phone: *

Email Address: *

Address: *

City, State, Zip: *

Age: *

Driver license number: *

Marital Status: *

Employer: *

Work Number: *

Family Members

Number of People Living in Home *

Person 1

First Name:

Last Name:

Age:

Relation:

Person 2

First Name:

Last Name:

Age:

Relation:

Person 3

First Name:

Last Name:

Age:

Relation:

Person 4

First Name:

Last Name:

Age:

Relation:

Person 5

First Name:

Last Name:

Age:

Relation:

Residence

Residence *

If renting, Landlord's Name:

Phone Number:

Have you lived in home more than 5 years? *

If No, Previous Address:

Address:

City:

State:

Do you currently have pets in your home now: (Note: all dogs in adopter's household must be spayed or neutered) *

If no pets currently in the household, have you had pets before? (If yes, please fill out following information for former pets.)

If pet is no longer in home, what happened to pet?:

Name/Breed:

Sex:

Spay/Neuter:

Age:

Owned Since:

Comments:

Name/Breed:

Sex:

Spay/Neuter:

Age:

Owned Since:

Comments:

Name/Breed:

Sex:

Spay/Neuter:

Age:

Owned Since:

Comments:

Name/Breed:

Sex:

Spay/Neuter:

Age:

Owned Since:

Comments:

Are they current on all vaccinations:

Name of Veterinarian:

Phone Number:

Name of Clinic:

What type of heartworm preventative do you use?

What type of flea preventative do you use?

Do you have a fenced in yard: *

Type of Fence:

Height of fence:

Do you have a pool? *

Will pet be an inside or outside pet: *

What do you think about crate training? *

Do you plan on going to obedience class with your new pet? *

Where will the pet be kept during the day: *

at night: *

In case of an emergency, or vacation, who will take care of your pet: *

Is this pet for you or a gift for someone else: *

How many hours per day will the pet be left without human companionship: *

Have you discussed adopting a pet with your family: *

Is everyone in agreement about adopting and taking responsibility for the pet: *

References

Please name three references: 2 family & 1 personal

Reference 1 - Name: *

Address:

Phone: *

Reference 2 - Name: *

Address:

Phone: *

Reference 3 - Name: *

Address:

Phone: *

Comments:

Please Note

When adopting a puppy please note that if the puppy is returned after 4 months, there will be a rehoming fee of $250.00. Puppies are a very big responsibility and should be seriously considered before adopting. Puppies need training and guidance to be the perfect pet. There are no bad puppies, only lack of knowledge and training by the owner. All puppies grow up to be dogs, and they still need the love and companionship of a family. AgreeDisagree

By signing below, I_______________________________ am declaring that all the information above is true and factual. I understand that CARES will do a vet check and has my permission to obtain reference and give permission to have medical information released on my pets. Agree to sign at time of adoptionDisagree to sign at time of adoption

Adoption Application

Adoption Application